夏科氏关节病对侧足部的中期转归。
Midterm Fate of the Contralateral Foot in Charcot Arthropathy.
机构信息
Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland.
Unit for Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland.
出版信息
Foot Ankle Int. 2020 Oct;41(10):1181-1189. doi: 10.1177/1071100720937654. Epub 2020 Jul 22.
BACKGROUND
The contralateral foot in Charcot arthropathy or neuroarthropathy (CN) is subject to increased plantar pressure. To date, the clinical consequences of this pressure elevation are yet to be determined. The aim of this study was to evaluate ulcer and amputation rates of the contralateral foot in CN.
METHODS
We abstracted the medical records of 130 consecutive subjects with unilateral CN. Rates of contralateral CN development and recurrence, contralateral ulcer development, and contralateral amputations were recorded. Statistical analysis was performed to identify possible risk factors for contralateral CN and ulcer development, and contralateral amputation. Mean follow-up was 6.2 (SD 4) years.
RESULTS
After a mean of 2.5 years, 19.2% patients developed contralateral CN. Female gender was associated with contralateral CN development (odds ratio 3.13, 95% confidence interval 1.27, 7.7). Overall, 46.2% patients developed a contralateral ulcer. Among the patients who developed contralateral CN, 60% developed an ulcer. Sanders type 2 at the index foot (midfoot CN) was significantly associated with contralateral ulcer development. Ulcer-free survival (UFS) differed significantly between patients with diabetes type 1 (median UFS 5131 days) and patients with diabetes type 2 (median UFS 2158 days). A total of 25 amputations had to be performed in 22 (16.9%) patients. Three of those 22 patients (2.3%) needed major amputation.
CONCLUSION
Almost 20% of patients developed contralateral CN. Nearly half of people with CN developed a contralateral foot ulceration. Patients with type 2 diabetes had significantly shorter UFS than patients with diabetes type 1. Every sixth patient needed an amputation, with the majority being minor amputations. The contralateral foot should be monitored closely and included in the treatment in patients with CN.
LEVEL OF EVIDENCE
Level IV, retrospective study.
背景
Charcot 关节病或神经关节病（CN）对侧足部的足底压力增加。迄今为止，这种压力升高的临床后果尚未确定。本研究旨在评估 CN 对侧足部溃疡和截肢的发生率。
方法
我们摘录了 130 例单侧 CN 连续患者的病历。记录对侧 CN 发展和复发、对侧溃疡发展和对侧截肢的发生率。进行统计学分析以确定对侧 CN 和溃疡发展以及对侧截肢的可能危险因素。平均随访 6.2（SD 4）年。
结果
平均 2.5 年后，19.2%的患者出现对侧 CN。女性与对侧 CN 发展相关（优势比 3.13，95%置信区间 1.27，7.7）。总体而言，46.2%的患者出现对侧溃疡。在出现对侧 CN 的患者中，60%出现溃疡。索引足（中足 CN）的桑德斯 2 型与对侧溃疡发展显著相关。溃疡无生存（UFS）在 1 型糖尿病患者（中位数 UFS 5131 天）和 2 型糖尿病患者（中位数 UFS 2158 天）之间有显著差异。22 名患者中有 25 名（16.9%）需要进行截肢，其中 3 名（2.3%）需要进行大截肢。
结论
近 20%的患者出现对侧 CN。近一半的 CN 患者出现对侧足部溃疡。2 型糖尿病患者的 UFS 明显短于 1 型糖尿病患者。每 6 名患者中就有 1 名需要截肢，其中大部分是小截肢。CN 患者应密切监测对侧足部并将其纳入治疗。
证据等级
IV 级，回顾性研究。
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